1 00:00:12,235 --> 00:00:17,433 Sync and corrections by btsix www.addic7ed.com 2 00:00:23,440 --> 00:00:25,441 Robby. 3 00:00:28,695 --> 00:00:30,279 Robby. 4 00:00:30,280 --> 00:00:31,905 College kid in respiratory distress is here. 5 00:00:31,906 --> 00:00:33,282 - All right. - You OK? 6 00:00:33,283 --> 00:00:35,075 Yep. 7 00:00:35,076 --> 00:00:37,119 I wanted to talk to the patient in Central 12's son, 8 00:00:37,120 --> 00:00:38,287 but he took off. 9 00:00:38,288 --> 00:00:39,413 Is there a problem? 10 00:00:39,414 --> 00:00:40,748 Uh, according to Mom, 11 00:00:40,749 --> 00:00:41,790 she found a list of high school girls 12 00:00:41,791 --> 00:00:44,835 that he'd like to eliminate. 13 00:00:44,836 --> 00:00:46,962 What's wrong with kids these days? 14 00:00:46,963 --> 00:00:48,922 Uh, you mean besides social media 15 00:00:48,923 --> 00:00:51,633 and the worldwide pandemic and the environmental crisis? 16 00:00:51,634 --> 00:00:53,469 - Yeah, yeah, yeah. - And gun violence? 17 00:00:53,470 --> 00:00:55,137 You're a fucking fountain of hope today, aren't you? 18 00:00:55,138 --> 00:00:57,931 Nick Bradley, 19, found unresponsive by parents. 19 00:00:57,932 --> 00:00:59,308 No meds, no allergies. 20 00:00:59,309 --> 00:01:00,934 On arrival, he was barely breathing 21 00:01:00,935 --> 00:01:03,270 with pinpoint pupils, bradycardic at 38. 22 00:01:03,271 --> 00:01:04,980 Pupils responded to Narcan, 23 00:01:04,981 --> 00:01:07,566 but we tubed him when his respirations didn't pick up. 24 00:01:07,567 --> 00:01:09,568 Any drugs or alcohol on the scene? 25 00:01:09,569 --> 00:01:11,111 - No. - Signs of trauma? 26 00:01:11,112 --> 00:01:12,321 Nothing. 27 00:01:12,322 --> 00:01:13,989 OK. Open your eyes, Nick. 28 00:01:13,990 --> 00:01:16,493 On three. One, two, three. 29 00:01:18,370 --> 00:01:21,663 - Where was he found? - In bed by his mom. 30 00:01:21,664 --> 00:01:26,168 Pupils are 6 millimeters, non-reactive. 31 00:01:26,169 --> 00:01:28,671 Heart rate's 64. BP is cycling. 32 00:01:28,672 --> 00:01:31,465 No response to pain. GCS 3. 33 00:01:31,466 --> 00:01:34,009 - Does that fit any toxidrome? - No. 34 00:01:34,010 --> 00:01:36,470 If it was just opiates with Narcan, 35 00:01:36,471 --> 00:01:38,806 he'd be breathing on his own. 36 00:01:38,807 --> 00:01:41,016 Uh, beta blockers shouldn't get pinpoint pupils. 37 00:01:41,017 --> 00:01:42,518 Maybe parents had some 38 00:01:42,519 --> 00:01:43,602 prescription meds in their bathroom. 39 00:01:43,603 --> 00:01:45,270 They're on their way. 40 00:01:45,271 --> 00:01:47,356 Code trauma, tier 1, ETA five minutes. 41 00:01:47,357 --> 00:01:49,692 That's a stand-up scooter rider versus car door. 42 00:01:49,693 --> 00:01:51,985 - No helmet. - No blood in the belly. 43 00:01:51,986 --> 00:01:57,074 No pericardial effusion, and lungs are up. 44 00:01:57,075 --> 00:01:58,992 Hemocue's good, 15. 45 00:01:58,993 --> 00:02:01,829 - BP 84 over 58. - OK. 46 00:02:01,830 --> 00:02:03,789 What's your plan, Dr. Collins? 47 00:02:03,790 --> 00:02:07,710 Um, push dose epi, 0.1 milligram. 48 00:02:07,711 --> 00:02:10,170 Foley for urine, stabilize for CT, 49 00:02:10,171 --> 00:02:13,382 and throw a wide net. 50 00:02:17,512 --> 00:02:18,846 Where... where are we going now? 51 00:02:18,847 --> 00:02:20,681 We need the room for someone else, 52 00:02:20,682 --> 00:02:23,685 but you can rest in the hall till we get your labs back. 53 00:02:25,311 --> 00:02:27,855 Your parents must be proud. 54 00:02:27,856 --> 00:02:30,065 Having a son for a doctor. 55 00:02:30,066 --> 00:02:32,735 Yeah, I guess. 56 00:02:32,736 --> 00:02:34,403 Um, you know, 57 00:02:34,404 --> 00:02:38,532 I was the first one in my family to go to college. 58 00:02:38,533 --> 00:02:42,369 You know, they sacrificed a lot to get me here. 59 00:02:42,370 --> 00:02:43,912 How's your pain, Mr. Milton? 60 00:02:43,913 --> 00:02:45,414 Uh, I'm fine. 61 00:02:45,415 --> 00:02:46,999 Could use a latte, though. 62 00:02:47,000 --> 00:02:49,251 That could bring back the gallstone pain. 63 00:02:49,252 --> 00:02:50,753 How about a bourbon? 64 00:02:50,754 --> 00:02:52,421 It's barely 8:00. 65 00:02:52,422 --> 00:02:54,757 Uh, how about some ice chips? 66 00:02:54,758 --> 00:02:56,759 No, thanks. 67 00:02:56,760 --> 00:02:58,594 I prefer my whiskey neat. 68 00:02:58,595 --> 00:02:59,970 Yeah, that's not happening. 69 00:03:04,684 --> 00:03:07,436 Systolic back down to 90. 70 00:03:07,437 --> 00:03:09,438 Another 0.1 of epi. 71 00:03:09,439 --> 00:03:13,233 Flaccid paralysis of all four extremities. 72 00:03:13,234 --> 00:03:16,111 No eye movement with ice water. 73 00:03:16,112 --> 00:03:17,696 So no brainstem function. 74 00:03:17,697 --> 00:03:19,073 Due to? 75 00:03:19,074 --> 00:03:21,492 Hypoxic injury, massive hemorrhage. 76 00:03:21,493 --> 00:03:23,744 Samira, escort him to CT. 77 00:03:23,745 --> 00:03:25,788 Take the drug box with you. 78 00:03:25,789 --> 00:03:27,289 Call me if you need me. 79 00:03:27,290 --> 00:03:29,833 Hey, are you OK? 80 00:03:29,834 --> 00:03:31,627 - Yep. - Are you sure? 81 00:03:31,628 --> 00:03:33,921 Have you ever had to worry about me? 82 00:03:33,922 --> 00:03:36,256 No, but it never hurts to check in. 83 00:03:36,257 --> 00:03:38,092 It's part of my job. 84 00:03:38,093 --> 00:03:40,427 Consider yourself checked in. 85 00:03:40,428 --> 00:03:41,930 OK. 86 00:03:42,972 --> 00:03:45,307 Ah, ah, ah, ah, ah. 87 00:03:45,308 --> 00:03:46,600 Got something? 88 00:03:46,601 --> 00:03:48,227 Oh, I had a case for Dr. Collins. 89 00:03:48,228 --> 00:03:50,604 - May I see? - Yeah. 90 00:03:50,605 --> 00:03:53,857 A 68-year-old male, history of hypertension, 91 00:03:53,858 --> 00:03:55,609 one hour of right upper quadrant pain 92 00:03:55,610 --> 00:03:57,820 after eating a fatty meal, now resolved. 93 00:03:57,821 --> 00:03:59,279 Afebrile, non-tender. 94 00:03:59,280 --> 00:04:01,156 There was a gallstone present on POCUS. 95 00:04:01,157 --> 00:04:03,659 EKG shows no acute ischemic changes, 96 00:04:03,660 --> 00:04:05,994 but I'm still waiting on LFTs and lipase. 97 00:04:05,995 --> 00:04:08,497 Why did you order the EKG? 98 00:04:08,498 --> 00:04:11,750 The nurse suggested it to rule out any cardiac issues. 99 00:04:11,751 --> 00:04:14,294 Well, good call on both your parts. 100 00:04:14,295 --> 00:04:15,629 Nurses know what they're doing. 101 00:04:15,630 --> 00:04:17,089 Never hesitate to listen to them. 102 00:04:17,090 --> 00:04:18,674 Come find me when those labs are back. 103 00:04:18,675 --> 00:04:20,134 - Hey, how's that finger? - Oh, it's nothing. 104 00:04:20,135 --> 00:04:21,552 - Dr. Robby? - Yep? 105 00:04:21,553 --> 00:04:23,012 The son and daughter of Mr. Spencer 106 00:04:23,013 --> 00:04:24,555 from assisted living, they're here. 107 00:04:24,556 --> 00:04:26,849 OK. I'll be right there. 108 00:04:33,648 --> 00:04:36,859 Your father has pneumonia and a condition called sepsis. 109 00:04:36,860 --> 00:04:38,777 What is... what is that exactly? 110 00:04:38,778 --> 00:04:41,113 It means that the bacteria has spread from his lung 111 00:04:41,114 --> 00:04:42,698 to his bloodstream. 112 00:04:42,699 --> 00:04:45,200 So far, he's been responding well to treatment. 113 00:04:45,201 --> 00:04:47,661 Hey, Pop. 114 00:04:47,662 --> 00:04:49,955 It's Helen and Jereme. 115 00:04:51,708 --> 00:04:54,168 Jereme... 116 00:04:54,169 --> 00:04:56,003 Hillary... 117 00:04:56,004 --> 00:04:57,212 Boob... 118 00:04:57,213 --> 00:04:58,881 Fud. 119 00:05:00,842 --> 00:05:03,761 It's the "Nowhere Man" from "Yellow Submarine." 120 00:05:03,762 --> 00:05:06,096 It's what he used to call me when I didn't do my homework. 121 00:05:06,097 --> 00:05:07,890 Is this his baseline? 122 00:05:07,891 --> 00:05:10,143 He has good days and bad days. 123 00:05:11,644 --> 00:05:13,855 Why don't we step out for one more second? 124 00:05:18,443 --> 00:05:20,652 So your father came in with low blood pressure, 125 00:05:20,653 --> 00:05:21,987 which is improving. 126 00:05:21,988 --> 00:05:23,572 Can he go back to assisted living? 127 00:05:23,573 --> 00:05:25,407 Eventually, we hope so. 128 00:05:25,408 --> 00:05:27,242 Your dad has an advanced directive 129 00:05:27,243 --> 00:05:28,911 expressing his wishes, which says that 130 00:05:28,912 --> 00:05:31,246 IV fluids and medications are OK, 131 00:05:31,247 --> 00:05:33,749 but no artificial life support, no CPR. 132 00:05:33,750 --> 00:05:36,543 He doesn't want a bunch of machines keeping him alive. 133 00:05:36,544 --> 00:05:38,212 OK. 134 00:05:38,213 --> 00:05:40,005 Then we will continue with oxygen 135 00:05:40,006 --> 00:05:42,508 and IV fluids and antibiotics, 136 00:05:42,509 --> 00:05:44,176 but if his lungs stop working, 137 00:05:44,177 --> 00:05:45,594 we're not going to place a tube in his windpipe 138 00:05:45,595 --> 00:05:46,762 for a breathing machine. 139 00:05:46,763 --> 00:05:49,223 But pneumonia is treatable? 140 00:05:49,224 --> 00:05:51,934 Most of the time, it is. 141 00:05:51,935 --> 00:05:53,018 But if he can get better in a week, 142 00:05:53,019 --> 00:05:54,269 then put him on a machine. 143 00:05:54,270 --> 00:05:56,105 That's not what he wanted. 144 00:05:56,106 --> 00:05:58,107 Do either of you have durable power of attorney 145 00:05:58,108 --> 00:05:59,650 for health care? 146 00:05:59,651 --> 00:06:00,943 - Yes. - We both do. 147 00:06:00,944 --> 00:06:02,111 OK. 148 00:06:02,112 --> 00:06:03,612 Well, this is a decision 149 00:06:03,613 --> 00:06:04,947 that does not need to be made right now. 150 00:06:04,948 --> 00:06:06,490 Why don't you think about it? 151 00:06:06,491 --> 00:06:08,075 Talk about it. 152 00:06:08,076 --> 00:06:11,954 If things get worse, sometimes allowing 153 00:06:11,955 --> 00:06:15,000 for a comfortable natural death can be the most humane path. 154 00:06:18,378 --> 00:06:21,255 No routine cases until we assess the tier 1. 155 00:06:21,256 --> 00:06:22,256 Thanks. 156 00:06:22,257 --> 00:06:24,800 Dr. Langdon? 157 00:06:24,801 --> 00:06:27,970 So, uh, how was the VA? 158 00:06:27,971 --> 00:06:30,681 Yeah, it was, uh good, uh, you know, challenging. 159 00:06:30,682 --> 00:06:33,308 I learned a ton. I just think it... 160 00:06:33,309 --> 00:06:34,643 maybe it should be mandatory 161 00:06:34,644 --> 00:06:35,686 that all doctors spend time there, 162 00:06:35,687 --> 00:06:37,187 like, on a regular basis 163 00:06:37,188 --> 00:06:39,189 because of all they've sacrificed for us. 164 00:06:39,190 --> 00:06:41,984 That's a nice thought. Why'd you choose the Pitt? 165 00:06:41,985 --> 00:06:43,444 Oh, I have a sister with special needs 166 00:06:43,445 --> 00:06:45,070 and she got into this really great facility 167 00:06:45,071 --> 00:06:46,447 here in Pittsburgh. 168 00:06:46,448 --> 00:06:48,157 And PTMC has such a great reputation, 169 00:06:48,158 --> 00:06:49,992 I thought, you know, it'd be a good fit. 170 00:06:49,993 --> 00:06:51,076 Can I present my headache to you? 171 00:06:51,077 --> 00:06:52,619 Uh, yeah, what do you got? 172 00:06:52,620 --> 00:06:54,496 A 36-year-old woman with severe headache 173 00:06:54,497 --> 00:06:56,331 due to paracervical trigger point. 174 00:06:56,332 --> 00:06:59,001 Her pain went from 11 to zero after 2 ccs of IM Marcaine 175 00:06:59,002 --> 00:07:00,336 - to the... - Wait, wait, wait. 176 00:07:00,337 --> 00:07:01,837 You did a trigger point injection 177 00:07:01,838 --> 00:07:03,505 - before presenting the case? - Yeah. I... 178 00:07:03,506 --> 00:07:05,799 Interns always present first. 179 00:07:05,800 --> 00:07:07,051 I spent a month at the pain clinic at Hopkins. 180 00:07:07,052 --> 00:07:08,844 - No, it's not OK. - Incoming! 181 00:07:08,845 --> 00:07:10,804 - I'm very comfortable with... - It's definitely not OK. 182 00:07:10,805 --> 00:07:12,556 23-year-old Ben Kemper, no helmet, 183 00:07:12,557 --> 00:07:14,433 got doored riding an e-scooter. 184 00:07:14,434 --> 00:07:16,435 Neck versus handlebar then face-planted to the pavement. 185 00:07:16,436 --> 00:07:18,020 Obvious facial fractures, 186 00:07:18,021 --> 00:07:19,981 but alert and oriented with good vitals. 187 00:07:22,359 --> 00:07:23,735 Here we go. 188 00:07:25,278 --> 00:07:27,572 One, two, three. 189 00:07:29,866 --> 00:07:31,200 How are we doing, Ben? 190 00:07:31,201 --> 00:07:33,577 Blood, back in my throat. 191 00:07:33,578 --> 00:07:35,371 That's probably from the nosebleed. 192 00:07:35,372 --> 00:07:37,247 Short Rapid Rhino, please. 193 00:07:37,248 --> 00:07:40,501 Tachy at 120, pulse ox borderline at 90. 194 00:07:40,502 --> 00:07:41,877 Blow by at 15 liters for now. 195 00:07:41,878 --> 00:07:43,420 - Neck contusion. - BP 138 over 84. 196 00:07:43,421 --> 00:07:45,130 Larynx shifted to the right, no crepitance. 197 00:07:45,131 --> 00:07:47,132 4 of morphine. 198 00:07:47,133 --> 00:07:51,637 I'm going to stick something in your nose to stop the bleeding. 199 00:07:51,638 --> 00:07:53,347 No hemotympanum. 200 00:07:53,348 --> 00:07:56,225 Inflate the balloon. 201 00:07:56,226 --> 00:07:58,686 How about now, Ben? 202 00:07:58,687 --> 00:08:01,188 - Better. - What's up? 203 00:08:01,189 --> 00:08:04,401 Good vitals, A and O, let's have a look. 204 00:08:08,196 --> 00:08:09,571 Ouch. 205 00:08:09,572 --> 00:08:12,324 - Floating face. - Le Fort III fracture. 206 00:08:12,325 --> 00:08:14,743 You don't see that every day. OK, let's prep for airway. 207 00:08:14,744 --> 00:08:17,037 Double setup just in case. 208 00:08:30,844 --> 00:08:34,096 - Nice work. - Thanks. 209 00:08:34,097 --> 00:08:36,140 All right, Mr. Tagari, you are good to go. 210 00:08:36,141 --> 00:08:37,808 Oh, thank you. 211 00:08:37,809 --> 00:08:42,146 Remember, 10% off for doctors and nurses. 212 00:08:42,147 --> 00:08:43,605 I'm a student doctor. 213 00:08:43,606 --> 00:08:45,607 Oh, right. Sorry. 214 00:08:45,608 --> 00:08:47,985 - I hit my head, remember? - Well, my son loves pizza, 215 00:08:47,986 --> 00:08:49,611 so I will take you up on it for sure, OK? 216 00:08:49,612 --> 00:08:50,821 - Thank you. Thank you. - Thank you. 217 00:08:50,822 --> 00:08:52,614 - Wait for a nurse. - OK, thanks. 218 00:08:52,615 --> 00:08:54,575 Hi. 219 00:08:54,576 --> 00:08:57,119 I just realized it sounds like I always feed my kid junk food. 220 00:08:57,120 --> 00:08:58,328 - Oh. - You know? 221 00:08:58,329 --> 00:08:59,913 Pizza, s'mores. 222 00:08:59,914 --> 00:09:02,791 No, no, please. I... I like pizza and s'mores. 223 00:09:02,792 --> 00:09:05,627 - Who doesn't? - Mm. 224 00:09:05,628 --> 00:09:09,131 - How many kids do you have? - Just one, Harrison. 225 00:09:09,132 --> 00:09:11,592 He's 11 now. 226 00:09:11,593 --> 00:09:12,968 What does your husband do? 227 00:09:12,969 --> 00:09:14,928 No husband, just me and my son. 228 00:09:14,929 --> 00:09:16,388 I take it you don't have kids? 229 00:09:16,389 --> 00:09:18,766 I... I don't mean on account of your age. 230 00:09:18,767 --> 00:09:20,392 Or maybe I do. 231 00:09:20,393 --> 00:09:22,311 I mean, most medical students don't have kids. 232 00:09:22,312 --> 00:09:25,939 Oh, yeah, no, no. Um, no kids. 233 00:09:25,940 --> 00:09:29,234 Just not even a boyfriend. Uh, it's just school for now. 234 00:09:29,235 --> 00:09:31,236 Yeah. That'll keep you pretty busy. 235 00:09:31,237 --> 00:09:33,530 I do not miss it. 236 00:09:33,531 --> 00:09:35,824 Must have been difficult as a young mother. 237 00:09:35,825 --> 00:09:37,326 It had its moments, 238 00:09:37,327 --> 00:09:39,036 but my life has been full of challenges, 239 00:09:39,037 --> 00:09:42,331 and med school was not one of the hardest, by far. 240 00:09:42,332 --> 00:09:44,667 It was one of the most rewarding, though. 241 00:09:44,668 --> 00:09:48,462 - Other than having my son. - Hey. 242 00:09:48,463 --> 00:09:50,881 Facial lash with possible foreign object in the eye, 243 00:09:50,882 --> 00:09:54,343 which is always a solid 7 on the WMMV Scale. 244 00:09:54,344 --> 00:09:56,011 What Makes Mateo Vomit. 245 00:09:59,265 --> 00:10:01,975 - You OK? - Yeah. 246 00:10:01,976 --> 00:10:05,521 Yeah. Um, he's funny, the... 247 00:10:05,522 --> 00:10:06,980 - the nurse. - Oh, Mateo. 248 00:10:06,981 --> 00:10:08,733 You can say his name. 249 00:10:09,943 --> 00:10:12,319 Um, yeah, uh... 250 00:10:12,320 --> 00:10:15,490 a foreign object in the eye could be really serious. 251 00:10:22,288 --> 00:10:25,457 Hey, Fruitcake. 252 00:10:25,458 --> 00:10:26,875 Hey, I'm talking to you, Fruitcake. 253 00:10:26,876 --> 00:10:28,627 Myrna, I told you a hundred times 254 00:10:28,628 --> 00:10:31,046 my name is Dr. Robby. 255 00:10:31,047 --> 00:10:33,173 You want to see my vagina? 256 00:10:33,174 --> 00:10:35,217 I have already seen it. 257 00:10:35,218 --> 00:10:38,095 And once was enough, thank you. 258 00:10:38,096 --> 00:10:40,180 Robby, parents of Nick Bradley, 259 00:10:40,181 --> 00:10:42,933 - the OD teen, are here. - OK, park them in Trauma 1. 260 00:10:42,934 --> 00:10:44,727 He's not back from CT yet. 261 00:10:44,728 --> 00:10:46,020 I'll be right there in a minute. 262 00:10:46,021 --> 00:10:47,354 Got it. Behaving yourself, Myrna? 263 00:10:47,355 --> 00:10:49,274 Oh, yes, ma'am. 264 00:10:52,944 --> 00:10:53,944 How we doing? 265 00:10:53,945 --> 00:10:55,070 Ketamine and sux on board. 266 00:10:55,071 --> 00:10:56,739 Pulse ox holding at 94. 267 00:10:56,740 --> 00:10:58,115 Prepping the neck just in case. 268 00:10:58,116 --> 00:10:59,199 Let's have a look. 269 00:11:01,411 --> 00:11:03,412 A little deeper. 270 00:11:03,413 --> 00:11:05,039 Lots of swelling. I can't see the cords. 271 00:11:05,040 --> 00:11:07,583 To the right. The left. 272 00:11:07,584 --> 00:11:09,084 Yeah, it really distorted from the trauma, 273 00:11:09,085 --> 00:11:10,252 and the edema's only going to get worse. 274 00:11:10,253 --> 00:11:11,712 Which is why we should crike. 275 00:11:11,713 --> 00:11:13,505 You don't crike a laryngeal fracture. 276 00:11:13,506 --> 00:11:14,757 Don't listen to Edwina Scissorhands here. 277 00:11:14,758 --> 00:11:16,175 If they can't cut it, 278 00:11:16,176 --> 00:11:17,760 surgery doesn't know how to fix it. 279 00:11:17,761 --> 00:11:19,428 The contusion is high at the thyroid cartilage, 280 00:11:19,429 --> 00:11:21,096 so you just stand there looking pretty, ER Ken, 281 00:11:21,097 --> 00:11:23,557 and let me fix this. 282 00:11:23,558 --> 00:11:24,933 - We're down to 85. - All right, pull out. 283 00:11:24,934 --> 00:11:27,227 - I-gel, bag and crike. - I-gel, please. 284 00:11:27,228 --> 00:11:28,520 Turn off the alarm. 285 00:11:28,521 --> 00:11:29,605 I've never done a crike before. 286 00:11:29,606 --> 00:11:30,939 No. Mel will do the crike. 287 00:11:30,940 --> 00:11:32,107 You've already had a busy morning. 288 00:11:32,108 --> 00:11:33,442 Glove up, Mel. 289 00:11:33,443 --> 00:11:34,943 No, I'm doing the crike, doctor. 290 00:11:34,944 --> 00:11:35,944 You would be doing it, doctor, 291 00:11:35,945 --> 00:11:37,446 if it wasn't an odd day. 292 00:11:37,447 --> 00:11:38,655 Surgery gets even days, ED gets odd days. 293 00:11:38,656 --> 00:11:40,407 You know this. For crikes' sake. 294 00:11:40,408 --> 00:11:42,076 That's because you're all fucking odd down here. 295 00:11:42,077 --> 00:11:43,827 OK, team work, please. Let's focus on the patient. 296 00:11:43,828 --> 00:11:45,829 I so appreciate your gracious understanding. 297 00:11:45,830 --> 00:11:47,581 I'll assist in case she screws up. 298 00:11:47,582 --> 00:11:49,625 Yolanda, play nice. 299 00:11:49,626 --> 00:11:51,168 Sats are up with the I-gel. 300 00:11:51,169 --> 00:11:53,629 You ready? Hello? 301 00:11:53,630 --> 00:11:55,422 Oh, uh, hello. 302 00:11:55,423 --> 00:11:56,924 You've done this? 303 00:11:56,925 --> 00:12:00,469 Yes, in the cadaver lab. 304 00:12:00,470 --> 00:12:03,472 Let's hope that's not where this poor soul ends up. 305 00:12:03,473 --> 00:12:05,349 We'll do an open technique since we have a minute. 306 00:12:05,350 --> 00:12:07,518 OK. 307 00:12:07,519 --> 00:12:09,603 OK, you're going to be making a vertical incision 308 00:12:09,604 --> 00:12:12,147 to avoid the jugulars in the carotids. 309 00:12:13,608 --> 00:12:15,401 Mm-hmm, good. 310 00:12:15,402 --> 00:12:17,069 If this was a crike that needed to happen in seconds, 311 00:12:17,070 --> 00:12:20,072 you could use a 10 blade, your finger, and a bougie. 312 00:12:23,410 --> 00:12:24,993 This is called a Weitlaner. 313 00:12:24,994 --> 00:12:27,454 And this is your trake hook. 314 00:12:27,455 --> 00:12:31,333 C-spine, head CT, OMF. Start a propofol drip. 315 00:12:31,334 --> 00:12:33,002 OK, now we're going to make a horizontal incision 316 00:12:33,003 --> 00:12:35,130 across the cricothyroid membrane. 317 00:12:37,549 --> 00:12:39,675 Yeah. 318 00:12:39,676 --> 00:12:41,677 4.0 Shiley next. 319 00:12:41,678 --> 00:12:42,929 Get ready to bag the crike. 320 00:12:44,723 --> 00:12:46,850 Yeah, yeah, yeah, good. 321 00:12:53,997 --> 00:12:55,024 Oh, excuse me. 322 00:12:55,025 --> 00:12:57,192 No worries. 323 00:12:57,193 --> 00:12:58,527 End tidal CO2 is yellow. 324 00:12:58,528 --> 00:13:00,070 Yellow is yes. Nicely done. 325 00:13:00,071 --> 00:13:03,157 Sew it in. OK, I will be next-door. 326 00:13:04,826 --> 00:13:06,160 Does your resident know how to suture, 327 00:13:06,161 --> 00:13:07,536 or do I need to teach? 328 00:13:07,537 --> 00:13:10,581 - You're all class, Yoyo. - I know, thanks. 329 00:13:10,582 --> 00:13:13,042 That means a lot of nothing coming from you. 330 00:13:13,043 --> 00:13:15,544 - Mel, you OK? - If you're done fighting. 331 00:13:15,545 --> 00:13:17,308 We're not fighting. This is playing. 332 00:13:17,309 --> 00:13:18,881 Langdon's too soft to fight. 333 00:13:18,882 --> 00:13:20,883 Oh, yeah, I have nothing but respect for Dr. Garcia. 334 00:13:20,884 --> 00:13:22,343 In fact, I think she would 335 00:13:22,344 --> 00:13:24,219 make a wonderful hostess at Applebee's. 336 00:13:24,220 --> 00:13:25,764 Later, Odds. 337 00:13:28,058 --> 00:13:29,850 Let's go. 338 00:13:29,851 --> 00:13:31,518 OK, thanks. 339 00:13:31,519 --> 00:13:33,979 Just received word your son's head CT is normal, 340 00:13:33,980 --> 00:13:35,814 and he's maintaining a good heart rate. 341 00:13:35,815 --> 00:13:38,025 - You got him back. - Thank you. Thank God. 342 00:13:38,026 --> 00:13:39,485 Right now, he's unconscious 343 00:13:39,486 --> 00:13:42,738 with a tube in his throat for oxygen. 344 00:13:42,739 --> 00:13:44,239 Why don't we step out for a minute while they 345 00:13:44,240 --> 00:13:45,783 get him settled, and then you can come back? 346 00:13:45,784 --> 00:13:48,243 You can sit with him as long as you want. 347 00:13:48,244 --> 00:13:50,746 Nicky, it's Mama. I'm here, baby. 348 00:13:50,747 --> 00:13:53,207 You're doing great, son. 349 00:13:53,208 --> 00:13:56,085 Blown. 350 00:13:56,086 --> 00:13:59,463 - OK, let's step outside. - OK. 351 00:14:05,595 --> 00:14:07,554 So we don't know 352 00:14:07,555 --> 00:14:09,598 how long he was at home without breathing. 353 00:14:09,599 --> 00:14:12,768 - He's breathing now. - Not on his own. 354 00:14:12,769 --> 00:14:14,103 But he's going to wake up. 355 00:14:14,104 --> 00:14:15,854 We certainly hope so. 356 00:14:15,855 --> 00:14:17,106 We're going to know better after 357 00:14:17,107 --> 00:14:18,607 we get some more test results back. 358 00:14:18,608 --> 00:14:21,360 Are you sure that he didn't take anything 359 00:14:21,361 --> 00:14:22,444 that could have caused this? 360 00:14:22,445 --> 00:14:24,196 No, no, he's a good kid. 361 00:14:24,197 --> 00:14:26,448 He's in college, he has a part-time job. 362 00:14:26,449 --> 00:14:29,743 He even chose to live at home so he could focus on school. 363 00:14:29,744 --> 00:14:31,620 Dr. Robby. From the urine. 364 00:14:31,621 --> 00:14:34,123 What's that? 365 00:14:34,124 --> 00:14:35,457 It's a drug test. 366 00:14:35,458 --> 00:14:38,085 And it is positive for fentanyl. 367 00:14:38,086 --> 00:14:40,796 No, that is impossible. Nick doesn't do drugs. 368 00:14:40,797 --> 00:14:43,132 There are a lot of pills that are sold illegally 369 00:14:43,133 --> 00:14:45,342 that have fentanyl, not just painkillers. 370 00:14:45,343 --> 00:14:47,094 Xanax, Ativan. 371 00:14:47,095 --> 00:14:49,596 - No, not our son. - Uh... 372 00:14:49,597 --> 00:14:51,181 Well, maybe he didn't know that he took something 373 00:14:51,182 --> 00:14:52,766 with fentanyl, I don't know. 374 00:14:52,767 --> 00:14:54,977 The hows and the whys don't really matter. 375 00:14:54,978 --> 00:14:56,979 What matters is spending time with Nick. 376 00:14:56,980 --> 00:14:58,313 We've got some more tests to run. 377 00:14:58,314 --> 00:14:59,440 We'll know our options after that, 378 00:14:59,441 --> 00:15:00,816 but in the meantime, 379 00:15:00,817 --> 00:15:02,736 why don't you take a seat and talk to him? 380 00:15:05,238 --> 00:15:06,488 Can he hear us? 381 00:15:06,489 --> 00:15:07,823 You know, we're never really sure, 382 00:15:07,824 --> 00:15:09,825 so we should assume that he can. 383 00:15:09,826 --> 00:15:12,161 And we'll come find you as soon as we know more, OK? 384 00:15:12,162 --> 00:15:13,162 OK. 385 00:15:19,753 --> 00:15:21,920 Can we move Nick Bradley to a private room? 386 00:15:21,921 --> 00:15:23,465 The kid going to make it? 387 00:15:24,924 --> 00:15:26,759 Didn't he respond to Narcan? 388 00:15:26,760 --> 00:15:28,802 I think his pinpoint pupils just grew into blown pupils 389 00:15:28,803 --> 00:15:29,928 from brainstem death. 390 00:15:29,929 --> 00:15:33,265 - Shit. - Yeah. 391 00:15:33,266 --> 00:15:35,809 Not much older than Jake. 392 00:15:35,810 --> 00:15:37,145 Don't go there. 393 00:15:38,188 --> 00:15:41,190 Hard not to sometimes. 394 00:15:41,191 --> 00:15:43,359 Mr. Spencer's room. 395 00:15:43,360 --> 00:15:45,194 Hey, Robby, 396 00:15:45,195 --> 00:15:47,363 Theresa, the mother of the young man David who bolted, 397 00:15:47,364 --> 00:15:48,697 she's asking for her son. 398 00:15:48,698 --> 00:15:50,199 OK. I'll be there in a minute. 399 00:15:50,200 --> 00:15:51,700 What is happening? 400 00:15:51,701 --> 00:15:54,536 Uh, his oxygen levels are dropping. 401 00:15:54,537 --> 00:15:56,830 Mr. Spencer, how are you feeling? 402 00:15:56,831 --> 00:15:59,375 I don't remember where I parked. 403 00:15:59,376 --> 00:16:01,335 Mr. Spencer, do you know where you are? 404 00:16:01,336 --> 00:16:03,712 It's so loud in here. 405 00:16:03,713 --> 00:16:06,215 Dad? Do you know where you are? 406 00:16:06,216 --> 00:16:08,676 Dad, look at me. What's my name? 407 00:16:08,677 --> 00:16:12,763 I don't know where my car is. 408 00:16:12,764 --> 00:16:14,515 BiPAP, 15 over 5. 409 00:16:14,516 --> 00:16:15,850 Let's step out. 410 00:16:20,146 --> 00:16:21,980 What's a BiPAP? 411 00:16:21,981 --> 00:16:25,317 It is a pressurized air mask that can improve his oxygen. 412 00:16:25,318 --> 00:16:26,735 Either his pneumonia is getting worse 413 00:16:26,736 --> 00:16:28,737 or his heart couldn't handle the fluids 414 00:16:28,738 --> 00:16:30,572 that we gave him to treat the sepsis. 415 00:16:30,573 --> 00:16:32,074 His lungs are filling up with fluid. 416 00:16:32,075 --> 00:16:33,534 Can't you take the fluid away? 417 00:16:33,535 --> 00:16:35,369 Not without his blood pressure crashing 418 00:16:35,370 --> 00:16:36,662 with very bad consequences, 419 00:16:36,663 --> 00:16:38,747 so let's just hope the BiPAP works. 420 00:16:38,748 --> 00:16:40,749 And if it doesn't? 421 00:16:40,750 --> 00:16:43,210 Then I would need to know your decision 422 00:16:43,211 --> 00:16:44,586 about using a breathing machine. 423 00:16:44,587 --> 00:16:46,588 We're still talking about it. 424 00:16:46,589 --> 00:16:48,924 Well, we know he expressed his wishes. 425 00:16:48,925 --> 00:16:50,968 In writing. "Do not intubate." 426 00:16:50,969 --> 00:16:54,096 We're thinking try it for a week. 427 00:16:54,097 --> 00:16:57,391 That would be a very painful week. 428 00:16:57,392 --> 00:17:00,102 He wouldn't get a lot of rest with all the monitors 429 00:17:00,103 --> 00:17:02,312 and all the blood tests. He might need to be sedated. 430 00:17:02,313 --> 00:17:03,814 He might need to be restrained 431 00:17:03,815 --> 00:17:05,941 because he'd be in an unfamiliar place 432 00:17:05,942 --> 00:17:08,569 with a very uncomfortable tube down his throat. 433 00:17:08,570 --> 00:17:10,904 And he wouldn't really know what was happening. 434 00:17:10,905 --> 00:17:14,408 Elderly patients can often develop psychosis. 435 00:17:14,409 --> 00:17:17,661 - But he might get better. - Or he might get worse. 436 00:17:17,662 --> 00:17:19,955 What would you do? 437 00:17:19,956 --> 00:17:21,707 I really can't answer that for you. 438 00:17:21,708 --> 00:17:23,250 This is your father. It's your decision to make. 439 00:17:23,251 --> 00:17:24,918 I can guarantee you 440 00:17:24,919 --> 00:17:26,754 that we will keep him as comfortable as possible 441 00:17:26,755 --> 00:17:28,589 if a natural death is what you choose. 442 00:17:28,590 --> 00:17:30,299 But he's not your father. 443 00:17:30,300 --> 00:17:32,092 And he can recover from this. 444 00:17:32,093 --> 00:17:33,802 What my sister means 445 00:17:33,803 --> 00:17:35,847 is that we're still deciding the best thing to do. 446 00:17:38,850 --> 00:17:40,976 Well, the sooner you decide, the better. 447 00:17:40,977 --> 00:17:42,311 I'm really sorry. 448 00:17:42,312 --> 00:17:44,313 I wish there was more that I could do. 449 00:17:44,314 --> 00:17:46,648 I'm not sure that he has that much time left. 450 00:17:53,031 --> 00:17:55,241 Dr. Robby. 451 00:18:01,581 --> 00:18:03,165 You were right. 452 00:18:03,166 --> 00:18:04,833 She can't say whether she was bumped by accident 453 00:18:04,834 --> 00:18:06,669 - or shoved on purpose. - No other witnesses? 454 00:18:06,670 --> 00:18:09,213 No, not really. 455 00:18:09,214 --> 00:18:11,173 We pulled security footage. Maybe we'll find something. 456 00:18:11,174 --> 00:18:13,467 Hopefully she tripped. 457 00:18:13,468 --> 00:18:14,885 I don't mean I hope she tripped. 458 00:18:14,886 --> 00:18:17,388 I mean I hope she wasn't pushed on purpose. 459 00:18:17,389 --> 00:18:19,348 That would this a hate crime. 460 00:18:19,349 --> 00:18:21,850 Yes, ma'am. 461 00:18:21,851 --> 00:18:24,019 - Ma'am? - Doctor. 462 00:18:24,020 --> 00:18:26,188 Sorry. I'm... I'm sorry. 463 00:18:26,189 --> 00:18:28,482 No harm, no foul. 464 00:18:28,483 --> 00:18:32,904 Will you let me know if she says anything else? 465 00:18:34,239 --> 00:18:35,907 Will do. 466 00:18:38,576 --> 00:18:39,868 At the risk of seeming... 467 00:18:39,869 --> 00:18:41,036 Then you probably shouldn't. 468 00:18:41,037 --> 00:18:43,372 - I just... - No, trust me. 469 00:18:43,373 --> 00:18:45,165 - How do you know... - I just know. 470 00:18:45,166 --> 00:18:48,127 - I just wanted... - I know. 471 00:18:48,128 --> 00:18:51,046 Look, I'll let you know if she says anything else 472 00:18:51,047 --> 00:18:53,800 that could be important to your investigation. 473 00:18:57,429 --> 00:18:59,263 Thank you. 474 00:18:59,264 --> 00:19:02,224 - You know, for the record... - Nope. 475 00:19:12,277 --> 00:19:15,237 Any luck getting our psych boarders upstairs? 476 00:19:15,238 --> 00:19:18,575 Yeah, right, at least the Kraken's still sleeping. 477 00:19:20,035 --> 00:19:21,201 Is it me or was that officer... 478 00:19:21,202 --> 00:19:23,245 - No. - What? 479 00:19:23,246 --> 00:19:26,540 - You don't even know what I... - What you were going to say? 480 00:19:26,541 --> 00:19:29,585 Maybe you do. 481 00:19:29,586 --> 00:19:31,545 - He seemed nice. - Absolutely not. 482 00:19:31,546 --> 00:19:33,422 Mm-mm. 483 00:19:33,423 --> 00:19:34,923 There is no possible scenario 484 00:19:34,924 --> 00:19:37,384 in which you and I have this conversation. 485 00:19:37,385 --> 00:19:39,261 You of all people should know better. 486 00:19:39,262 --> 00:19:42,014 - I was... - No. 487 00:19:42,015 --> 00:19:43,599 Just walk away. 488 00:19:43,600 --> 00:19:46,769 Best possible scenario. Just keep on walking. 489 00:19:46,770 --> 00:19:48,604 Mm-hmm. 490 00:19:48,605 --> 00:19:51,565 You got to lay off mixing Adderall and energy drinks. 491 00:19:51,566 --> 00:19:52,900 Trust me, I will. 492 00:19:52,901 --> 00:19:55,028 All right. Thanks. 493 00:19:56,321 --> 00:19:57,780 That's the thing about emergency medicine. 494 00:19:57,781 --> 00:19:59,281 You never know what you're going to get. 495 00:19:59,282 --> 00:20:01,158 And we get everything. 496 00:20:01,159 --> 00:20:02,451 Is that why you chose it? 497 00:20:02,452 --> 00:20:04,119 Maybe a little. 498 00:20:04,120 --> 00:20:05,621 I also get to pick my shifts, 499 00:20:05,622 --> 00:20:08,290 which, for a single mother, is amazing. 500 00:20:08,291 --> 00:20:11,001 But mostly, I just like the people, you know? 501 00:20:11,002 --> 00:20:12,670 They're always there when you need them. 502 00:20:12,671 --> 00:20:14,296 Who wouldn't want to be a part of that, you know? 503 00:20:16,966 --> 00:20:18,967 Fuck off. 504 00:20:25,225 --> 00:20:27,101 This is the monitoring center. 505 00:20:27,102 --> 00:20:28,977 We see that you are not in your inclusion zone. 506 00:20:28,978 --> 00:20:31,063 Do you have permission to be outside this area? 507 00:20:31,064 --> 00:20:33,607 Yes, I am at work. 508 00:20:33,608 --> 00:20:37,444 Just like last time and the time before that. 509 00:20:38,947 --> 00:20:40,155 I'll be right back. 510 00:20:42,158 --> 00:20:44,660 What is the point of this fucking thing 511 00:20:44,661 --> 00:20:46,286 if it doesn't even work? 512 00:20:54,045 --> 00:20:55,421 Sorry. 513 00:20:55,422 --> 00:20:57,423 You're doing great. Take your time. 514 00:20:57,424 --> 00:20:58,465 You OK? 515 00:20:58,466 --> 00:20:59,967 I am... yeah. 516 00:20:59,968 --> 00:21:01,343 I get frustrated when I can't do things, 517 00:21:01,344 --> 00:21:02,845 or at least it looks like it. 518 00:21:02,846 --> 00:21:05,055 Yeah, you and me both. 519 00:21:05,056 --> 00:21:08,392 Thanks, but my frustration manifests itself emotionally, 520 00:21:08,393 --> 00:21:10,310 and then, uh, I get upset, 521 00:21:10,311 --> 00:21:12,146 and then it looks like I can't handle things, 522 00:21:12,147 --> 00:21:14,314 and, you know, then I can't cry in front of the patient 523 00:21:14,315 --> 00:21:15,524 because no one wants to see their doctor cry. 524 00:21:15,525 --> 00:21:17,234 That's just a big red flag. 525 00:21:17,235 --> 00:21:20,530 You just did a perfect crike. You're doing great. 526 00:21:23,658 --> 00:21:25,659 Hey, you! Pasty white! 527 00:21:25,660 --> 00:21:27,077 How about a sandwich? 528 00:21:27,078 --> 00:21:30,372 Uh, what brings you here today, sir? 529 00:21:30,373 --> 00:21:33,292 I'm here for a fucking sandwich. 530 00:21:33,293 --> 00:21:35,044 OK. 531 00:21:35,045 --> 00:21:37,963 OK, uh, excuse me... 532 00:21:37,964 --> 00:21:39,381 - Perlah. - Perlah. 533 00:21:39,382 --> 00:21:41,216 Can this patient get a sandwich? 534 00:21:41,217 --> 00:21:42,718 I already gave you a sandwich, Earl. 535 00:21:42,719 --> 00:21:45,637 I ain't ate this whole week. 536 00:21:45,638 --> 00:21:47,306 Sure. 537 00:21:47,307 --> 00:21:49,141 Give him another sandwich. They're on the food cart. 538 00:21:49,142 --> 00:21:50,351 Just make sure it's not egg salad, 539 00:21:50,352 --> 00:21:51,894 or he'll throw it on the floor. 540 00:21:51,895 --> 00:21:53,772 OK. Good to know. Thanks. 541 00:22:08,286 --> 00:22:09,912 Any quick ones up here? 542 00:22:09,913 --> 00:22:11,747 It's only 8:30, and Robby's already on my case 543 00:22:11,748 --> 00:22:13,707 for being too slow. 544 00:22:13,708 --> 00:22:14,792 I can usually at least make it to lunch 545 00:22:14,793 --> 00:22:16,418 before he starts hounding me. 546 00:22:16,419 --> 00:22:18,295 Cut him a little slack today, OK? 547 00:22:18,296 --> 00:22:20,923 It's the anniversary of Dr. Adamson's death. 548 00:22:20,924 --> 00:22:23,550 That's sad. 549 00:22:23,551 --> 00:22:26,220 But it's still no reason to take it out on me. 550 00:22:26,221 --> 00:22:27,930 I'm just saying. 551 00:22:27,931 --> 00:22:30,432 - Dr. Mohan? - Samira, please. 552 00:22:30,433 --> 00:22:32,434 I just wanted to apologize. 553 00:22:32,435 --> 00:22:35,521 When my phone went off earlier, that was really unprofessional. 554 00:22:35,522 --> 00:22:36,897 Don't sweat it. Trust me. 555 00:22:36,898 --> 00:22:38,273 We need to laugh. 556 00:22:38,274 --> 00:22:39,775 Otherwise, we'd never stop crying. 557 00:22:39,776 --> 00:22:41,110 Thank you. 558 00:22:41,111 --> 00:22:42,569 Besides, with all the craziness 559 00:22:42,570 --> 00:22:43,904 that comes through here every hour, 560 00:22:43,905 --> 00:22:45,698 nobody cares or notices. 561 00:22:45,699 --> 00:22:48,075 Got an unresponsive unhoused man coming in. 562 00:22:48,076 --> 00:22:52,163 Might be a good teaching case, Funky Music. 563 00:22:54,290 --> 00:22:55,624 Let's go. 564 00:22:55,625 --> 00:22:56,959 Caucasian male, 565 00:22:56,960 --> 00:22:58,627 approximately 60 to 70 years old, 566 00:22:58,628 --> 00:23:02,007 found unresponsive. No signs of trauma, no ID. 567 00:23:03,383 --> 00:23:05,092 On three. 568 00:23:05,093 --> 00:23:07,387 One, two, three. 569 00:23:09,681 --> 00:23:12,099 Oof. Did you take anything? 570 00:23:12,100 --> 00:23:13,600 I smell the alcohol from here. 571 00:23:13,601 --> 00:23:14,810 This guy's wearing the spring, summer, 572 00:23:14,811 --> 00:23:15,978 and fall collection. 573 00:23:17,105 --> 00:23:18,313 Oh! Whoa! 574 00:23:18,314 --> 00:23:20,107 - Jesus, uh... - Oh, oh, oh! 575 00:23:20,108 --> 00:23:21,150 What the... 576 00:23:21,151 --> 00:23:22,484 Oh! 577 00:23:22,485 --> 00:23:25,154 Uh, what's wrong? What's going on? 578 00:23:25,155 --> 00:23:28,157 Patient tested positive for rats. 579 00:23:28,158 --> 00:23:29,533 No. 580 00:23:29,534 --> 00:23:33,120 If it matters, I only counted three. 581 00:23:33,121 --> 00:23:34,621 Oh, there goes one. 582 00:23:39,085 --> 00:23:41,253 Because your son tested positive for THC, 583 00:23:41,254 --> 00:23:43,422 the psychoactive ingredient in cannabis, 584 00:23:43,423 --> 00:23:45,090 we're going to have to admit him for overnight 585 00:23:45,091 --> 00:23:47,092 observation and monitoring. 586 00:23:47,093 --> 00:23:49,178 And what about his brain? 587 00:23:49,179 --> 00:23:51,597 Is there a chance that much pot is going to do some damage? 588 00:23:51,598 --> 00:23:53,015 He's only four. 589 00:23:53,016 --> 00:23:54,683 The honest answer is we don't know. 590 00:23:54,684 --> 00:23:56,268 There haven't been any long-term studies, 591 00:23:56,269 --> 00:23:58,020 but the fact that this is a one-time occurrence 592 00:23:58,021 --> 00:24:00,189 suggests that there should be no long-term effects. 593 00:24:00,190 --> 00:24:01,940 But you don't know. 594 00:24:01,941 --> 00:24:04,109 So my son could end up with learning disabilities, 595 00:24:04,110 --> 00:24:06,570 psychiatric problems, or even autism because of this. 596 00:24:06,571 --> 00:24:08,364 There's no evidence to suggest any of that. 597 00:24:08,365 --> 00:24:11,158 Hello. I'm Kiara Alfaro. 598 00:24:11,159 --> 00:24:13,035 I'm the department social worker. 599 00:24:13,036 --> 00:24:15,996 Kiara will help you navigate the next steps. 600 00:24:15,997 --> 00:24:17,247 What steps? 601 00:24:17,248 --> 00:24:18,832 Well, a case like this 602 00:24:18,833 --> 00:24:21,877 requires mandatory reporting to child services 603 00:24:21,878 --> 00:24:23,921 - and sometimes law enforcement. - No. 604 00:24:23,922 --> 00:24:25,089 Why... why do you have to involve the police? 605 00:24:25,090 --> 00:24:26,423 It's a controlled substance. 606 00:24:26,424 --> 00:24:28,092 They're not taking my kid away. 607 00:24:28,093 --> 00:24:30,010 - They were pot gummies. - No one's suggesting that. 608 00:24:30,011 --> 00:24:32,096 Well, fuck your suggestions! No one is touching my child! 609 00:24:32,097 --> 00:24:33,597 In fact, we're leaving. 610 00:24:33,598 --> 00:24:35,099 Well you... no, you can't take your son. 611 00:24:35,100 --> 00:24:36,725 He could stop breathing. He could have a seizure. 612 00:24:36,726 --> 00:24:38,310 - I will observe him at home. - Amanda, please. 613 00:24:38,311 --> 00:24:39,978 - Fuck off, Drew. - Get security. 614 00:24:39,979 --> 00:24:41,355 If you can't cooperate, 615 00:24:41,356 --> 00:24:42,731 I'm going to have to ask you to leave. 616 00:24:42,732 --> 00:24:44,233 Amanda, please. He needs to stay here. 617 00:24:44,234 --> 00:24:45,984 And you need to get a fucking hotel. 618 00:24:45,985 --> 00:24:47,236 Your son can't leave the hospital, 619 00:24:47,237 --> 00:24:48,570 but I can have you removed. 620 00:24:48,571 --> 00:24:49,905 Don't you dare touch me. 621 00:24:49,906 --> 00:24:51,573 Get out! All of you! 622 00:24:51,574 --> 00:24:53,742 Mrs. Jones, I know this is scary and stressful. 623 00:24:53,743 --> 00:24:55,911 Oh, fuck you! Fuck you! This is my son. 624 00:24:55,912 --> 00:24:57,246 My son! And nobody is touching him! 625 00:24:57,247 --> 00:24:58,914 Whoa, whoa, whoa. What's going on? 626 00:24:58,915 --> 00:25:00,332 - How can I help you? - By backing the fuck off! 627 00:25:00,333 --> 00:25:01,917 Mom's worried a CYF investigation. 628 00:25:01,918 --> 00:25:03,919 - Amanda, just calm down! - OK, OK, OK, enough! 629 00:25:03,920 --> 00:25:05,337 This is a hospital. 630 00:25:05,338 --> 00:25:06,922 This isn't "The Jerry Springer Show." 631 00:25:06,923 --> 00:25:09,425 Ma'am, nobody's trying to take your child, 632 00:25:09,426 --> 00:25:11,093 so why don't you stay here with him 633 00:25:11,094 --> 00:25:12,886 while your husband talks to our social worker outside 634 00:25:12,887 --> 00:25:14,555 and straightens all this out? 635 00:25:14,556 --> 00:25:16,932 Well, I don't want him speaking for me and my son. 636 00:25:16,933 --> 00:25:18,892 Well, it is either you or him. 637 00:25:18,893 --> 00:25:21,895 Your son is not leaving, but you can be escorted out 638 00:25:21,896 --> 00:25:23,939 and even arrested if you refuse to cooperate. 639 00:25:23,940 --> 00:25:25,441 Nobody wants that. 640 00:25:25,442 --> 00:25:27,485 So you tell us. What do you want to do? 641 00:25:30,447 --> 00:25:33,240 - I'm staying with my son. - OK, great. 642 00:25:33,241 --> 00:25:35,075 You do that. 643 00:25:35,076 --> 00:25:37,453 We all on the same page here? 644 00:25:37,454 --> 00:25:38,829 Thank you, Olsen. 645 00:25:38,830 --> 00:25:39,872 - You know where to find me. - You OK? 646 00:25:39,873 --> 00:25:41,623 Yeah, we got this. 647 00:25:41,624 --> 00:25:43,459 - All good. - It's all yours. 648 00:25:43,460 --> 00:25:45,210 Mrs. Jones, we just have a couple things. 649 00:25:48,465 --> 00:25:49,798 Everything all right out there? 650 00:25:49,799 --> 00:25:52,134 Yeah, just another day in paradise. 651 00:25:52,135 --> 00:25:54,094 - How are you feeling? - Better. 652 00:25:54,095 --> 00:25:56,638 - Where's David? - He left. 653 00:25:56,639 --> 00:25:59,475 He said he had to get back to school. 654 00:25:59,476 --> 00:26:01,101 Oh. 655 00:26:01,102 --> 00:26:02,895 Um, maybe you could try calling him, 656 00:26:02,896 --> 00:26:04,105 get him to come back. 657 00:26:06,858 --> 00:26:09,735 What's going to happen to him if I do? 658 00:26:09,736 --> 00:26:11,987 Hopefully he'll be willing to talk to somebody. 659 00:26:11,988 --> 00:26:14,615 - Will you talk to him? - I can try. 660 00:26:14,616 --> 00:26:17,326 I don't think he wanted to talk to me. 661 00:26:17,327 --> 00:26:19,661 Have you shared with anyone 662 00:26:19,662 --> 00:26:21,789 about the writings of his you found? 663 00:26:21,790 --> 00:26:23,540 No. 664 00:26:23,541 --> 00:26:25,292 I didn't know who to tell. 665 00:26:25,293 --> 00:26:27,503 I just don't want to see him get hurt. 666 00:26:27,504 --> 00:26:29,381 Neither do we. 667 00:26:38,682 --> 00:26:40,057 It's just going straight to voicemail. 668 00:26:40,058 --> 00:26:42,227 Maybe if you can text him. 669 00:26:54,531 --> 00:26:56,615 He's not texting back. 670 00:26:56,616 --> 00:26:58,200 Oh, I'm sorry about all this. 671 00:26:58,201 --> 00:26:59,702 It's OK, it's OK. 672 00:26:59,703 --> 00:27:02,955 What are you doing for David is very brave. 673 00:27:02,956 --> 00:27:04,206 I'm his mother. 674 00:27:04,207 --> 00:27:06,334 I'll do anything to protect him. 675 00:27:08,294 --> 00:27:09,545 Do you think he would hurt anyone? 676 00:27:09,546 --> 00:27:11,256 No. 677 00:27:12,924 --> 00:27:16,927 But... 678 00:27:16,928 --> 00:27:20,723 I'm sure a lot of parents felt that way 679 00:27:20,724 --> 00:27:23,685 before their children did unspeakable things. 680 00:27:26,312 --> 00:27:27,730 Does he have any history of violence? 681 00:27:27,731 --> 00:27:29,189 Has he ever been in any trouble? 682 00:27:29,190 --> 00:27:30,607 No, never. 683 00:27:30,608 --> 00:27:33,068 He's very quiet. 684 00:27:33,069 --> 00:27:35,446 And he takes great care of me. 685 00:27:35,447 --> 00:27:40,951 He... he's struggled with his father's death. 686 00:27:40,952 --> 00:27:42,911 We both have. 687 00:27:42,912 --> 00:27:45,247 Flight is ten minutes out with an electrocution. 688 00:27:45,248 --> 00:27:48,334 OK, grab Collins. I'll be right there. 689 00:27:48,335 --> 00:27:49,752 Keep trying to reach him. 690 00:27:49,753 --> 00:27:51,378 If you do, have someone come find me. 691 00:27:51,379 --> 00:27:53,756 - OK? - OK. 692 00:27:53,757 --> 00:27:55,883 - Thank you. - Of course. 693 00:27:55,884 --> 00:27:58,052 - You got some good news for me? - I sure do. 694 00:27:58,053 --> 00:27:59,678 There are two rooms in ICU being cleaned. 695 00:27:59,679 --> 00:28:01,430 - They'll be ready by now. - Great. 696 00:28:01,431 --> 00:28:02,556 And I got bagels in the lounge. 697 00:28:02,557 --> 00:28:04,099 Nice job. Thank you. 698 00:28:06,519 --> 00:28:09,063 - Is it true? - You have to be more specific. 699 00:28:09,064 --> 00:28:10,689 Are there rats in the ED? 700 00:28:10,690 --> 00:28:13,025 Uh, apparently, if somebody already snitched. 701 00:28:13,026 --> 00:28:15,444 Do you know how bad this looks? 702 00:28:15,445 --> 00:28:17,446 One more reason to shutter this place. 703 00:28:17,447 --> 00:28:19,656 Only the emergency department admits rats. 704 00:28:19,657 --> 00:28:21,283 Emergency department would never admit rats, 705 00:28:21,284 --> 00:28:22,826 unless they had the right insurance. 706 00:28:22,827 --> 00:28:24,244 Did you catch any of them? 707 00:28:24,245 --> 00:28:25,996 One, and I charged him for a full visit. 708 00:28:25,997 --> 00:28:27,581 I'm glad you think this is funny. 709 00:28:27,582 --> 00:28:28,749 I'm sorry that you don't. 710 00:28:28,750 --> 00:28:30,501 Did you call an exterminator? 711 00:28:30,502 --> 00:28:32,294 He's waiting on a second opinion. 712 00:28:32,295 --> 00:28:35,506 You're pushing your luck today. 713 00:28:35,507 --> 00:28:36,799 Don't worry. Last I heard, 714 00:28:36,800 --> 00:28:38,175 they were headed for the cafeteria, 715 00:28:38,176 --> 00:28:39,343 so they should be dead within the hour. 716 00:28:39,344 --> 00:28:40,803 OK. 717 00:28:40,804 --> 00:28:43,681 - I'll be here all week. - Or maybe not. 718 00:28:47,310 --> 00:28:49,603 Drug-seeking woman kicked off the city bus 719 00:28:49,604 --> 00:28:50,979 for disrupting and disturbing passengers. 720 00:28:50,980 --> 00:28:52,564 I called 911! 721 00:28:52,565 --> 00:28:54,316 She's been screaming for narcotics nonstop. 722 00:28:54,317 --> 00:28:55,943 We found an empty Percocet bottle filled five days ago. 723 00:28:55,944 --> 00:28:57,111 What are you doing? What are you doing? 724 00:28:57,112 --> 00:28:58,570 She's been uncooperative 725 00:28:58,571 --> 00:28:59,780 and combative since we picked her up. 726 00:28:59,781 --> 00:29:01,156 Get off her. Let her go. 727 00:29:01,157 --> 00:29:02,741 Stop fighting. 728 00:29:02,742 --> 00:29:04,576 Calm the fuck down, or I'm calling the cops. 729 00:29:04,577 --> 00:29:06,286 My meds at home aren't working! 730 00:29:06,287 --> 00:29:08,497 Please, I have sickle cell! 731 00:29:08,498 --> 00:29:10,290 OK, stop. Everybody stop. 732 00:29:10,291 --> 00:29:11,960 Stop! 733 00:29:12,669 --> 00:29:14,294 What's your name? 734 00:29:14,295 --> 00:29:16,505 It's Joyce. It's Joyce St. Claire. 735 00:29:16,506 --> 00:29:18,716 Joyce, is this your sickle cell pain? 736 00:29:18,717 --> 00:29:21,010 - Yes! - 10 milligrams of IV morphine. 737 00:29:21,011 --> 00:29:22,344 - You really want 10? - Yes. 738 00:29:22,345 --> 00:29:23,512 Repeat it in five minutes if needed. 739 00:29:23,513 --> 00:29:24,847 And she needs a Dilaudid drip. 740 00:29:24,848 --> 00:29:25,973 This is a vaso-occlusive crisis! 741 00:29:25,974 --> 00:29:27,141 I'm so sorry this happened. 742 00:29:27,142 --> 00:29:28,726 You're going to be OK now. 743 00:29:28,727 --> 00:29:29,852 You're safe here, I promise. 744 00:29:29,853 --> 00:29:31,353 Come on. 745 00:29:31,354 --> 00:29:33,022 You're going to be safe here. I promise. 746 00:29:33,023 --> 00:29:34,857 Just breathe. OK? 747 00:30:00,216 --> 00:30:01,800 Live wire hit his left forearm, 748 00:30:01,801 --> 00:30:03,510 shocked him once for v-fib. 749 00:30:03,511 --> 00:30:05,554 - Was there a power pole down? - No, abandoned factory. 750 00:30:05,555 --> 00:30:06,638 We found bolt cutters at his side. 751 00:30:06,639 --> 00:30:07,890 Got electrocuted. 752 00:30:07,891 --> 00:30:08,891 Was he trying to steal copper? 753 00:30:08,892 --> 00:30:09,892 Most likely. 754 00:30:09,893 --> 00:30:11,810 Powerline fried his arm, 755 00:30:11,811 --> 00:30:14,688 and the current through his whole body stopped his heart. 756 00:30:14,689 --> 00:30:17,358 Ready? 757 00:30:17,359 --> 00:30:19,527 Steady, lift. 758 00:30:21,279 --> 00:30:24,073 Add a myoglobin and a CK to the labs. 759 00:30:24,074 --> 00:30:26,075 Two liters normal saline wide open. 760 00:30:26,076 --> 00:30:27,868 Dr. Santos, what are we worried about? 761 00:30:27,869 --> 00:30:30,788 Um, rhabdomyolysis from tissue damage 762 00:30:30,789 --> 00:30:33,749 can kill the kidneys, ongoing risk of cardiac irritability. 763 00:30:33,750 --> 00:30:35,376 - Excellent. - AP pads in place. 764 00:30:35,377 --> 00:30:37,086 Guy fell off a telephone pole? 765 00:30:37,087 --> 00:30:39,421 - No, he was on a platform. - Boring. 766 00:30:39,422 --> 00:30:41,965 Cut into a live wire. 767 00:30:41,966 --> 00:30:43,634 Tense ventral compartment. 768 00:30:43,635 --> 00:30:45,094 Set up the STIC pressure monitor. 769 00:30:45,095 --> 00:30:46,595 V-fib. 770 00:30:46,596 --> 00:30:48,055 - All right, charge to 300. - Charge to 300. 771 00:30:48,056 --> 00:30:49,264 Am I running this or are you? 772 00:30:49,265 --> 00:30:51,392 - Sorry, reflex response. - Clear. 773 00:30:52,769 --> 00:30:54,103 Ah, fuck! 774 00:30:54,104 --> 00:30:55,604 Sorry. 775 00:30:55,605 --> 00:30:57,106 Sorry. 776 00:30:57,107 --> 00:30:59,692 So what... what happened? 777 00:30:59,693 --> 00:31:02,236 I bought it for my girlfriend's dog. 778 00:31:02,237 --> 00:31:06,281 I work nights, and he yaps all day long. 779 00:31:06,282 --> 00:31:08,951 And when I woke up, I was wearing it. 780 00:31:08,952 --> 00:31:10,536 Stupid bitch! 781 00:31:11,913 --> 00:31:14,915 Sorry, sorry. 782 00:31:14,916 --> 00:31:17,418 I think she must have used Krazy Glue. 783 00:31:17,419 --> 00:31:20,754 Yeah, it, um, it looks that way. 784 00:31:20,755 --> 00:31:22,464 Have you tried removing the batteries? 785 00:31:22,465 --> 00:31:26,468 Of course. She glued the case shut. 786 00:31:26,469 --> 00:31:29,346 All right, I think we have a couple options, Gary. 787 00:31:29,347 --> 00:31:32,433 Um, we can try to find a solvent that will dissolve 788 00:31:32,434 --> 00:31:34,852 or at least soften the glue enough for you to peel it off 789 00:31:34,853 --> 00:31:36,979 without taking your skin with it. 790 00:31:36,980 --> 00:31:39,189 Or, um... 791 00:31:39,190 --> 00:31:41,775 - Dr. Javadi? - Um... 792 00:31:41,776 --> 00:31:44,820 I... I guess your skin cells on your neck will naturally 793 00:31:44,821 --> 00:31:48,323 slough off and you should just be able to remove it in time. 794 00:31:48,324 --> 00:31:51,368 - How much time? - Um, couple of weeks, maybe. 795 00:31:51,369 --> 00:31:52,703 Couple weeks? 796 00:31:52,704 --> 00:31:54,329 I think this guy's got scurvy. 797 00:31:54,330 --> 00:31:55,497 What is he, a pirate? 798 00:31:55,498 --> 00:31:57,166 No, he's an unhoused man 799 00:31:57,167 --> 00:31:59,752 who lives almost exclusively on dollar store ramen. 800 00:31:59,753 --> 00:32:02,338 There's perifollicular hemorrhage, gingivitis, 801 00:32:02,339 --> 00:32:04,673 bleeding gums, and, um, yeah, 802 00:32:04,674 --> 00:32:06,133 no fruit or vegetables in his diet. 803 00:32:06,134 --> 00:32:07,426 I suppose that could do it 804 00:32:07,427 --> 00:32:09,261 as long as you've ruled out piracy. 805 00:32:09,262 --> 00:32:12,348 No parrot, no peg leg, doesn't reek of sweat and rum? 806 00:32:12,349 --> 00:32:14,308 Well, now that you mention it, there was a smell. 807 00:32:14,309 --> 00:32:17,311 Probably a pirate. 808 00:32:17,312 --> 00:32:18,687 Tell him to pick up some vitamin C 809 00:32:18,688 --> 00:32:20,231 next time he docks at a dollar store. 810 00:32:22,525 --> 00:32:24,193 I can't tell if you're joking. 811 00:32:24,194 --> 00:32:26,528 No, Captain Scurvy's got a vitamin C deficiency. 812 00:32:26,529 --> 00:32:29,031 Cheapest way to fix it is with a daily supplement. 813 00:32:29,032 --> 00:32:30,866 Captain Scurvy is another joke. 814 00:32:30,867 --> 00:32:32,868 - I'd like to think so. - It's a good one. 815 00:32:32,869 --> 00:32:34,912 Dr. Langdon, Dr. King, this is Arthur Carlson 816 00:32:34,913 --> 00:32:36,663 from Children, Youth, and Families. 817 00:32:36,664 --> 00:32:38,540 He'd like to speak to the parents of Tyler Jones. 818 00:32:38,541 --> 00:32:40,417 Right, right. 819 00:32:40,418 --> 00:32:42,920 Uh, Mel, would you mind showing him to Kiara and the family? 820 00:32:42,921 --> 00:32:44,422 Mm. Yeah, right this way. 821 00:32:49,302 --> 00:32:51,053 - Beto? - Hello, Doctor. 822 00:32:51,054 --> 00:32:54,431 - What are you doing here? - I'm working day shifts now. 823 00:32:54,432 --> 00:32:56,392 Didn't you retire a couple of years ago? 824 00:32:56,393 --> 00:32:57,893 No. 825 00:32:57,894 --> 00:33:01,063 - I have to work today. - Right. 826 00:33:01,064 --> 00:33:02,648 Right. Just stay right here, OK? 827 00:33:02,649 --> 00:33:04,566 I... I have a lot of cleaning to do. 828 00:33:04,567 --> 00:33:06,527 Yeah, no, I'll be just one second. 829 00:33:06,528 --> 00:33:08,862 Hey, Doc, Doc! How about a sandwich? 830 00:33:08,863 --> 00:33:10,656 Sure, Earl. Turkey, no egg salad. 831 00:33:10,657 --> 00:33:12,908 I got you. Just give me one minute. 832 00:33:14,994 --> 00:33:16,829 So Beto said he's working here? 833 00:33:16,830 --> 00:33:18,372 Yeah, he just started wandering. 834 00:33:18,373 --> 00:33:20,541 Fortunately, he always winds up back here. 835 00:33:20,542 --> 00:33:22,251 He thinks he still works in the ED. 836 00:33:22,252 --> 00:33:23,752 I called his family. 837 00:33:23,753 --> 00:33:25,045 They usually pick him up after a few hours. 838 00:33:25,046 --> 00:33:26,171 Really? 839 00:33:26,172 --> 00:33:27,589 Yeah. It gives them a break. 840 00:33:27,590 --> 00:33:29,091 And look at him. He's talking to people, 841 00:33:29,092 --> 00:33:31,468 feeling useful, getting some exercise. 842 00:33:31,469 --> 00:33:33,095 Hell, I wish I was that happy. 843 00:33:33,096 --> 00:33:34,763 You think he's any good at catching rats? 844 00:33:34,764 --> 00:33:37,433 - Stop. - Oh, Earl wants a sandwich. 845 00:33:37,434 --> 00:33:39,393 He always wants a sandwich. 846 00:33:39,394 --> 00:33:40,811 Hey, check it out. 847 00:33:40,812 --> 00:33:42,396 I got my kids a puppy. 848 00:33:42,397 --> 00:33:44,565 Cute. Hope that wasn't your idea. 849 00:33:44,566 --> 00:33:46,316 - Why? - Seriously? 850 00:33:46,317 --> 00:33:47,651 You really think your wife 851 00:33:47,652 --> 00:33:49,111 needs anything else to take care of? 852 00:33:49,112 --> 00:33:51,238 - Abby loves dogs. - I love penguins. 853 00:33:51,239 --> 00:33:52,781 It doesn't mean I want to take care of one. 854 00:33:52,782 --> 00:33:54,324 I'm pretty sure it's illegal to own a penguin. 855 00:33:54,325 --> 00:33:55,826 Pretty sure you're missing the point. 856 00:33:55,827 --> 00:33:57,286 The point is Tanner promised 857 00:33:57,287 --> 00:33:58,579 he would take care of it. 858 00:33:58,580 --> 00:34:01,623 A four-year-old? Yeah, OK. 859 00:34:06,796 --> 00:34:08,547 How's she doing? 860 00:34:08,548 --> 00:34:11,593 Still breathing after 20 of morphine. 861 00:34:13,803 --> 00:34:15,137 How's the pain, Joyce? 862 00:34:15,138 --> 00:34:17,806 A little better. 863 00:34:17,807 --> 00:34:19,892 We've ordered an exchange transfusion. 864 00:34:19,893 --> 00:34:22,394 Mm. Figured I needed that. 865 00:34:22,395 --> 00:34:24,938 What's your normal regimen at home? 866 00:34:24,939 --> 00:34:28,817 90 of extended-release morphine every 12 hours 867 00:34:28,818 --> 00:34:31,153 and oxycodone for breakthrough pain, 868 00:34:31,154 --> 00:34:33,655 but it wasn't working. 869 00:34:33,656 --> 00:34:36,825 Starting IV Dilaudid of four an hour. 870 00:34:36,826 --> 00:34:39,161 You can press this button if you need a little extra. 871 00:34:39,162 --> 00:34:42,831 That only works once an hour, though, so don't go crazy. 872 00:34:42,832 --> 00:34:45,752 - Could I confer with you? - Yeah. 873 00:34:54,469 --> 00:34:57,012 You seem surprised by the opioid dosage. 874 00:34:57,013 --> 00:34:59,556 - It seemed a little high. - So was her pain. 875 00:34:59,557 --> 00:35:01,183 How do you know she's not drug-seeking? 876 00:35:01,184 --> 00:35:03,018 You can't fake a hemoglobin of 6. 877 00:35:03,019 --> 00:35:05,104 Do you know what sickle cell crisis does to the body? 878 00:35:05,105 --> 00:35:06,647 Blood cells get caught and plug up your capillaries 879 00:35:06,648 --> 00:35:08,357 and deprive all your cells of oxygen. 880 00:35:08,358 --> 00:35:11,193 It's been described as an electrical stabbing pain 881 00:35:11,194 --> 00:35:12,695 that feels like it's breaking your bones 882 00:35:12,696 --> 00:35:15,447 and flushing glass through your body. 883 00:35:15,448 --> 00:35:17,282 I never thought of it like that. 884 00:35:17,283 --> 00:35:18,659 Little empathy goes a long way 885 00:35:18,660 --> 00:35:20,412 with those suffering in real pain. 886 00:35:22,539 --> 00:35:23,956 - Yeah. - Don't worry. 887 00:35:23,957 --> 00:35:25,457 You'll get good at spotting the fakers, 888 00:35:25,458 --> 00:35:27,334 and half the time, all those people need 889 00:35:27,335 --> 00:35:29,921 is someone to really listen to them and hear their story. 890 00:35:31,423 --> 00:35:33,007 Mm-hmm. 891 00:35:33,008 --> 00:35:36,885 Interior compartment pressure is 49. 892 00:35:36,886 --> 00:35:38,595 Burn caused massive swelling. 893 00:35:38,596 --> 00:35:40,514 What does he need, Dr. Santos? 894 00:35:40,515 --> 00:35:43,434 Fasciotomy, but he still has a radial pulse. 895 00:35:43,435 --> 00:35:45,519 Pressure would have to be over 100 to lose the pulse, 896 00:35:45,520 --> 00:35:47,187 and at that point, he'd lose the arm. 897 00:35:47,188 --> 00:35:49,231 49 is enough to destroy all the nerves and muscles 898 00:35:49,232 --> 00:35:51,066 in a matter of hours. 899 00:35:51,067 --> 00:35:52,776 - Compartment pressure's 49? - Yeah. 900 00:35:52,777 --> 00:35:54,737 I'm going to make the initial incision down here. 901 00:35:54,738 --> 00:35:56,447 Ortho can finish it up in the OR. 902 00:35:56,448 --> 00:35:58,282 Good plan. I'll let them know. 903 00:35:58,283 --> 00:36:00,075 - Hey, Robby. - Always good to see you, Fred. 904 00:36:00,076 --> 00:36:01,368 - How do you like my rock star? - She's pretty good. 905 00:36:01,369 --> 00:36:03,912 She has a great teacher. 906 00:36:03,913 --> 00:36:05,914 Sterile gloves for Dr. Santos. 907 00:36:05,915 --> 00:36:09,209 Oh, we don't teach forearm fasciotomies to our residents. 908 00:36:09,210 --> 00:36:11,170 What if she's all alone somewhere someday 909 00:36:11,171 --> 00:36:13,381 with no backup? 910 00:36:15,425 --> 00:36:18,594 This is the path to avoid the median nerve 911 00:36:18,595 --> 00:36:20,763 and all major vessels. 912 00:36:20,764 --> 00:36:23,098 Maybe just watch the first time. 913 00:36:23,099 --> 00:36:25,517 She'll hold the blade, I'll cut. 914 00:36:25,518 --> 00:36:27,062 10 blade to Dr. Santos. 915 00:36:30,648 --> 00:36:33,067 We'll start proximal. 916 00:36:33,068 --> 00:36:34,485 How much pressure? 917 00:36:34,486 --> 00:36:37,655 Just about this much. 918 00:36:41,868 --> 00:36:43,286 Mm-hmm. 919 00:36:45,997 --> 00:36:48,541 Through the skin and sub-Q. 920 00:36:53,004 --> 00:36:54,421 Good. 921 00:36:58,677 --> 00:37:00,511 How they making out? 922 00:37:00,512 --> 00:37:02,263 They're still talking. 923 00:37:03,723 --> 00:37:05,766 - You OK? - Yeah, for sure. 924 00:37:05,767 --> 00:37:07,935 I just... I hate seeing families torn apart. 925 00:37:07,936 --> 00:37:09,478 Oh, they'll be fine. 926 00:37:09,479 --> 00:37:11,980 - How can you be sure? - They're white. 927 00:37:11,981 --> 00:37:14,274 Probably get off with a slap on the wrist. 928 00:37:14,275 --> 00:37:16,777 If they weren't, she'd probably lose her child 929 00:37:16,778 --> 00:37:20,406 and he'd end up going to jail, but... 930 00:37:20,407 --> 00:37:23,325 Sorry, I did a fellowship in cynicism. 931 00:37:23,326 --> 00:37:24,827 You sure you're OK? 932 00:37:24,828 --> 00:37:26,955 100%. I'm just going to get some air. 933 00:37:32,836 --> 00:37:35,671 I am a savage, classy, bougie, 934 00:37:35,672 --> 00:37:38,507 ratchet, sassy, moody, nasty. 935 00:37:38,508 --> 00:37:40,509 I am a savage... 936 00:37:40,510 --> 00:37:42,845 I need help! 937 00:37:42,846 --> 00:37:44,013 I got shot. 938 00:37:44,014 --> 00:37:45,222 Can you guys help? 939 00:37:45,223 --> 00:37:47,474 What's your name? 940 00:37:47,475 --> 00:37:48,642 Alex. 941 00:37:48,643 --> 00:37:50,853 OK, Alex, let me take a look. 942 00:37:50,854 --> 00:37:52,187 It fucking hurts. 943 00:37:52,188 --> 00:37:54,189 Oh, I know. All right. 944 00:37:54,190 --> 00:37:55,357 We're going to take good care of you. 945 00:37:55,358 --> 00:37:57,026 - Yeah. - You guys got it? 946 00:37:57,027 --> 00:37:59,236 Let me get you up here, Alex. 947 00:37:59,237 --> 00:38:00,988 I got you. 948 00:38:00,989 --> 00:38:02,364 I have an abdominal GSW 949 00:38:02,365 --> 00:38:05,159 in the ambulance bay, code trauma now. 950 00:38:05,160 --> 00:38:07,786 GSW just got dumped by a homeboy ambulance. 951 00:38:07,787 --> 00:38:10,831 - You got this? - Yeah, go. 952 00:38:10,832 --> 00:38:14,169 2 grams of Ancef. Ortho's on their way. 953 00:38:17,922 --> 00:38:20,549 Systolic's only 80. 14 gauge left AC. 954 00:38:20,550 --> 00:38:21,717 We got two units of whole blood 955 00:38:21,718 --> 00:38:23,052 going on the rapid infuser. 956 00:38:23,053 --> 00:38:24,386 Call the OR. We'll be right up. 957 00:38:24,387 --> 00:38:25,721 Lungs up. 958 00:38:25,722 --> 00:38:26,889 Do you take medications every day? 959 00:38:26,890 --> 00:38:28,849 - Any allergies? - No. 960 00:38:28,850 --> 00:38:30,309 Morrison's is full of blood. You see that? 961 00:38:30,310 --> 00:38:32,186 - Yeah. - Tore up his liver. 962 00:38:32,187 --> 00:38:33,562 - What's his name? - Alex. 963 00:38:33,563 --> 00:38:34,980 Alex, you've lost a lot of blood. 964 00:38:34,981 --> 00:38:36,315 You need to go to surgery right away. 965 00:38:36,316 --> 00:38:37,316 Am I going to die? 966 00:38:37,317 --> 00:38:38,776 Not now that I'm here. 967 00:38:38,777 --> 00:38:40,069 Spoken with the humility of a surgeon. 968 00:38:40,070 --> 00:38:41,403 OR's ready. How's he doing? 969 00:38:41,404 --> 00:38:43,113 - BP is coming up a bit. - Let's go. 970 00:38:43,114 --> 00:38:44,907 - Can you call my mom? - Yep. 971 00:38:44,908 --> 00:38:47,576 - She's the "ICE" on my cell. - Of course, of course. 972 00:38:47,577 --> 00:38:50,120 So he didn't have to wait for an OR? 973 00:38:50,121 --> 00:38:51,955 No, we're a trauma center. 974 00:38:51,956 --> 00:38:54,416 We always keep one OR stocked and ready to go. 975 00:38:54,417 --> 00:38:58,087 Well, that's awesome! 976 00:38:58,088 --> 00:39:01,090 What... what happens if there are multiple traumas needing OR? 977 00:39:01,091 --> 00:39:02,717 We get a lot busier. 978 00:39:04,636 --> 00:39:06,095 Mr. Milton, I'm sorry. 979 00:39:06,096 --> 00:39:07,805 We had to move you into the hall. 980 00:39:07,806 --> 00:39:09,765 I know it gets pretty chaotic and noisy out here. 981 00:39:09,766 --> 00:39:12,267 Mr. Milton? 982 00:39:12,268 --> 00:39:14,813 Hey, hey, Bennet, wake up for me. 983 00:39:17,148 --> 00:39:19,984 Oh, shit, shit, shit. Um, I need a little help here! 984 00:39:21,152 --> 00:39:22,444 Help! 985 00:39:22,445 --> 00:39:24,029 When did you check on him last? 986 00:39:24,030 --> 00:39:25,614 I don't know, around half an hour ago at most. 987 00:39:25,615 --> 00:39:27,116 - I was waiting on labs. - What's going on? 988 00:39:27,117 --> 00:39:28,784 It's my gallstone guy. You saw his EKGs. 989 00:39:28,785 --> 00:39:31,453 Unknown downtime. He was sleeping in the hall. 990 00:39:31,454 --> 00:39:33,455 Crash cart, let's go! 991 00:39:36,459 --> 00:39:38,419 I got it. 992 00:39:40,839 --> 00:39:42,464 Hold compressions. 993 00:39:44,592 --> 00:39:46,176 Asystole. 994 00:39:46,177 --> 00:39:49,972 Resume compressions, amp of epi. 995 00:39:49,973 --> 00:39:51,432 Slower, slower tempo, slower tempo. 996 00:39:51,433 --> 00:39:53,350 - Should I intubate? - No. Drop an LMA. 997 00:39:53,351 --> 00:39:56,020 We don't want to hold compressions. 998 00:39:56,021 --> 00:39:58,147 Pupils are fixed and dilated. 999 00:39:58,148 --> 00:39:59,607 He's been down a long time. 1000 00:40:11,619 --> 00:40:12,995 How we doing in here? 1001 00:40:12,996 --> 00:40:14,496 So much better. 1002 00:40:14,497 --> 00:40:17,124 Dr. Mohan, this is my wife, Ondine. 1003 00:40:17,125 --> 00:40:19,752 Dr. Samira Mohan. Nice to meet you, Ondine. 1004 00:40:19,753 --> 00:40:21,920 - Thank you for helping her. - Of course. 1005 00:40:21,921 --> 00:40:24,673 And, again, I'm so sorry about how you were treated 1006 00:40:24,674 --> 00:40:26,342 when you first arrived. 1007 00:40:26,343 --> 00:40:27,760 Not everyone who works here 1008 00:40:27,761 --> 00:40:29,678 is accustomed to dealing with sickle cell. 1009 00:40:29,679 --> 00:40:31,138 We will be doing everything possible 1010 00:40:31,139 --> 00:40:33,807 from here on in to manage Joyce's crisis. 1011 00:40:33,808 --> 00:40:35,684 In the meantime, can I get you anything? 1012 00:40:35,685 --> 00:40:36,685 I'm fine. 1013 00:40:36,686 --> 00:40:38,187 - Ondine? - No, thank you. 1014 00:40:38,188 --> 00:40:39,646 OK. Well, have the nurses come find me 1015 00:40:39,647 --> 00:40:40,815 if you need anything. 1016 00:40:43,526 --> 00:40:45,903 Take slow, deep breaths for me, Ian. 1017 00:40:45,904 --> 00:40:48,906 They ordered a neb, 5 albuterol, 125 solumedrol. 1018 00:40:48,907 --> 00:40:50,532 All right. 1019 00:40:50,533 --> 00:40:52,201 Keep an eye on him and present to Dr. Langdon. 1020 00:40:52,202 --> 00:40:54,328 - OK. - OK, great. 1021 00:40:54,329 --> 00:40:56,538 I'll see you back in triage once he settles down. 1022 00:40:56,539 --> 00:40:58,415 Yeah. 1023 00:40:58,416 --> 00:40:59,541 OK, let's take this off. 1024 00:40:59,542 --> 00:41:01,001 All right, hang in there, Ian. 1025 00:41:01,002 --> 00:41:02,837 This should really help your asthma. 1026 00:41:12,764 --> 00:41:13,889 How can I help you, hon? 1027 00:41:13,890 --> 00:41:15,307 Um, I'm looking for Dr. Langdon. 1028 00:41:15,308 --> 00:41:17,143 Yeah, let me see where he is. 1029 00:41:20,647 --> 00:41:22,481 Dr. Langdon, we have a med student 1030 00:41:22,482 --> 00:41:24,109 at Central looking for you. 1031 00:41:25,652 --> 00:41:27,403 Copy that. He's headed this way. 1032 00:41:27,404 --> 00:41:28,613 Thanks. 1033 00:41:29,823 --> 00:41:31,073 Hey, Crash. 1034 00:41:31,074 --> 00:41:33,575 You missed a pretty cool fasciotomy. 1035 00:41:33,576 --> 00:41:34,910 I'm not sure I'd be describing 1036 00:41:34,911 --> 00:41:36,495 a fasciotomy as cool. 1037 00:41:36,496 --> 00:41:39,206 You would if you were the one who did it. 1038 00:41:39,207 --> 00:41:42,335 How's it going out in the arrivals lounge? 1039 00:41:44,295 --> 00:41:47,256 Do you know anything about Dr. McKay? 1040 00:41:47,257 --> 00:41:49,591 I've been here for less than two hours. 1041 00:41:49,592 --> 00:41:52,761 I don't know anybody, including you. 1042 00:41:52,762 --> 00:41:55,639 I thought you were some kind of kid genius. 1043 00:41:55,640 --> 00:41:58,100 I'm like any other third-year med student. 1044 00:41:58,101 --> 00:42:00,978 Clearly. 1045 00:42:00,979 --> 00:42:02,438 Hey, I'm just trying to break the ice. 1046 00:42:02,439 --> 00:42:04,481 I'm not trying to annoy you. 1047 00:42:04,482 --> 00:42:06,442 And yet, you're still calling me Crash 1048 00:42:06,443 --> 00:42:07,818 when I asked you not to. 1049 00:42:07,819 --> 00:42:09,611 Really? You're still on that? 1050 00:42:09,612 --> 00:42:11,031 Still on that. 1051 00:42:12,323 --> 00:42:15,242 Yep. OK, sorry. 1052 00:42:15,243 --> 00:42:20,205 I had no idea genius was so sensitive. 1053 00:42:20,206 --> 00:42:23,292 But I get it. Big brain, big feelings. 1054 00:42:23,293 --> 00:42:24,752 Makes total sense. 1055 00:42:24,753 --> 00:42:26,671 I'll try to be softer. 1056 00:42:50,612 --> 00:42:51,945 We switch out every few minutes. 1057 00:42:51,946 --> 00:42:53,614 - You can take a break. - I'm fine. 1058 00:42:53,615 --> 00:42:54,865 Hold compressions. 1059 00:42:56,826 --> 00:42:58,494 Still in asystole. 1060 00:42:58,495 --> 00:43:00,996 Resume compressions. 1061 00:43:00,997 --> 00:43:02,331 Should we shock him? 1062 00:43:02,332 --> 00:43:03,791 You don't shock asystole. 1063 00:43:03,792 --> 00:43:05,042 It could be fine v-fib. 1064 00:43:05,043 --> 00:43:07,711 - Not a chance. - OK. 1065 00:43:07,712 --> 00:43:08,962 Uh, when was his last epi? 1066 00:43:08,963 --> 00:43:10,673 - Three minutes ago. - OK. 1067 00:43:10,674 --> 00:43:12,049 Well, ACLS says every three to five minute, right? 1068 00:43:12,050 --> 00:43:14,635 - So let's push another round. - Fine. 1069 00:43:14,636 --> 00:43:17,513 Robby, Mr. Spencer's adult children are asking for you. 1070 00:43:17,514 --> 00:43:19,431 And the parents of Nick Bradley, 1071 00:43:19,432 --> 00:43:21,350 the fentanyl overdose, also want to speak with you. 1072 00:43:21,351 --> 00:43:22,768 OK. 1073 00:43:22,769 --> 00:43:25,979 Three rounds of epi and then call it. 1074 00:43:25,980 --> 00:43:28,524 Mr. Spencer's maxed out on BiPAP, 25 on 10. 1075 00:43:28,525 --> 00:43:31,527 - Sats? - Not great, High 80s. 1076 00:43:34,364 --> 00:43:36,115 Hi. I heard you wanted to talk to me. 1077 00:43:36,116 --> 00:43:37,950 Yeah. That alarm kept going off. 1078 00:43:37,951 --> 00:43:40,953 Yeah. Why don't we step outside? 1079 00:43:40,954 --> 00:43:43,288 The alarm is for low oxygen. 1080 00:43:43,289 --> 00:43:45,541 Does he need more of that, um, BiPAP? 1081 00:43:45,542 --> 00:43:47,626 I'm afraid that's as high as we go. 1082 00:43:47,627 --> 00:43:49,378 So the decision at this point is... 1083 00:43:49,379 --> 00:43:52,382 We want you to put our father on the breathing machine. 1084 00:43:54,175 --> 00:43:55,884 Even though that goes against his desires 1085 00:43:55,885 --> 00:43:58,220 to not be intubated? 1086 00:43:58,221 --> 00:44:00,723 We're not ready to let go yet. 1087 00:44:00,724 --> 00:44:03,810 And if your father is? 1088 00:44:05,311 --> 00:44:06,770 He was a stubborn son of a bitch 1089 00:44:06,771 --> 00:44:09,356 who would never have given up on either of us. 1090 00:44:09,357 --> 00:44:12,109 We're not giving up on him. 1091 00:44:12,110 --> 00:44:14,111 You're absolutely certain you want 1092 00:44:14,112 --> 00:44:16,239 to put your father through this after everything I've told you? 1093 00:44:20,744 --> 00:44:24,913 I may have to honor his advanced directive. 1094 00:44:24,914 --> 00:44:29,043 No, you have to honor our durable power for health care. 1095 00:44:29,044 --> 00:44:32,505 If not, we can talk to your hospital attorney. 1096 00:44:35,008 --> 00:44:37,259 Jereme, you're on board with this? 1097 00:44:37,260 --> 00:44:39,512 Yeah, I guess so. 1098 00:44:41,181 --> 00:44:43,891 OK. You can sit with him until we're ready. 1099 00:44:43,892 --> 00:44:46,060 - And when will that be? - Momentarily. 1100 00:44:57,655 --> 00:44:58,989 Please don't tell me 1101 00:44:58,990 --> 00:45:00,324 you're going to intubate that poor man. 1102 00:45:00,325 --> 00:45:02,076 It's what the family wants. 1103 00:45:02,077 --> 00:45:03,786 So what? They want to torture him? 1104 00:45:03,787 --> 00:45:06,288 I explained all that. 1105 00:45:06,289 --> 00:45:10,292 If I co-sign, you can override their durable power. 1106 00:45:10,293 --> 00:45:12,127 They're threatening to go to the hospital attorney. 1107 00:45:12,128 --> 00:45:13,587 Let them. Call the Ethics Committee. 1108 00:45:13,588 --> 00:45:14,797 They'll agree with us. 1109 00:45:14,798 --> 00:45:16,131 No, no, you're probably right. 1110 00:45:16,132 --> 00:45:17,633 But we don't have that kind of time. 1111 00:45:17,634 --> 00:45:19,426 We are stuck. 1112 00:45:19,427 --> 00:45:22,555 - What are you talking about? - Shit. 1113 00:45:24,724 --> 00:45:26,141 What? 1114 00:45:26,142 --> 00:45:27,559 I got to go tell those parents 1115 00:45:27,560 --> 00:45:30,062 their 18-year-old son is brain-dead. 1116 00:45:30,063 --> 00:45:32,648 - Want me to come with you? - No, It's OK. 1117 00:45:32,649 --> 00:45:33,982 What are you going to say? 1118 00:45:33,983 --> 00:45:35,442 I'm going to say that it's likely, 1119 00:45:35,443 --> 00:45:36,985 but we still need to do an apnea test 1120 00:45:36,986 --> 00:45:40,072 and a cerebral perfusion study. 1121 00:45:40,073 --> 00:45:41,782 There's no cranial nerve activity. 1122 00:45:41,783 --> 00:45:45,619 - Those people need some hope. - False hope. 1123 00:45:45,620 --> 00:45:47,746 - Hope is hope. - Is it? 1124 00:45:47,747 --> 00:45:51,333 What, are we praying for miracles today? 1125 00:45:51,334 --> 00:45:52,835 They need time to process 1126 00:45:52,836 --> 00:45:55,838 before they can accept what's happening. 1127 00:45:55,839 --> 00:45:59,299 You ever consider taking that advice? 1128 00:45:59,300 --> 00:46:02,386 Physician, heal thyself. 1129 00:46:02,387 --> 00:46:04,014 Don't you have patients? 1130 00:46:26,578 --> 00:46:29,288 No, no, no, no, no, no. People wake up from comas. 1131 00:46:29,289 --> 00:46:31,373 You can wake him up. 1132 00:46:31,374 --> 00:46:33,667 You can do that. You can... you can shock... 1133 00:46:33,668 --> 00:46:36,211 you can... you can shock him back. 1134 00:46:41,718 --> 00:46:44,678 Nick. 1135 00:46:52,270 --> 00:46:53,812 Hey, hey, hey. 1136 00:46:53,813 --> 00:46:55,564 Hey, hey, hey, hey, hey. 1137 00:46:55,565 --> 00:46:57,566 Nick. 1138 00:46:59,736 --> 00:47:03,530 Please, no! 1139 00:48:07,929 --> 00:48:10,973 No change. 1140 00:48:10,974 --> 00:48:12,474 No pericardial effusion, 1141 00:48:12,475 --> 00:48:16,437 no tension pneumothorax, no cardiac activity. 1142 00:48:16,438 --> 00:48:18,647 Try calcium. Could be hyperkalemia. 1143 00:48:18,648 --> 00:48:20,691 No, his potassium was normal. 1144 00:48:20,692 --> 00:48:23,277 - Ready to call this? - Not yet. 1145 00:48:23,278 --> 00:48:25,279 Dr. Robby said three rounds of epi. 1146 00:48:25,280 --> 00:48:26,822 It's time. Let's push another amp. 1147 00:48:26,823 --> 00:48:28,450 This one could do it. 1148 00:48:31,036 --> 00:48:32,161 OK. 1149 00:48:38,168 --> 00:48:42,993 Sync and corrections by btsix www.addic7ed.com